Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • Current News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Custom Media Event: ESG Summit
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Transformation Summit
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain Revenue Cycle
    • - Hospital at Home
    • - Workplace of the Future
    • - Virtual Health
    • - Future of Healthcare Staffing
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Transformation Hub

Where healthcare challenges find solutions

  • Patients
  • Operations
  • Care Delivery
  • Payment
Patients
July 06, 2018 01:00 AM

CMS' hospital star-ratings system changes will be modest

Maria Castellucci
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print

    The CMS plans to tweak, not trash, its hospital star-rating methodology, a senior agency official told Modern Healthcare.

    The modest changes, slated to be announced in December, are likely to disappoint some hospital leaders who hoped the CMS would nix its current model entirely.

    The agency couldn't yet disclose specific changes to the methodology because it's still eliciting feedback from stakeholders and experts, but the CMS official said the changes will likely involve finding a way to mitigate the impact that changes to measures have on hospitals' overall ratings.

    "That is what we are going to be looking at, are there ways in which we can attenuate that significant impact for some hospitals so it's not quite as dramatic when a measure changes significantly," the official said.

    The agency announced last month it would delay the July release of the star ratings after hospitals expressed concern over changes.

    The CMS defended its current methodology, which relies on the latent variable model. The agency said the model works well because it's flexible enough to "accommodate changes in measures over time," the official said.

    The latent variable model is a statistical approach that gives more emphasis to certain measures over others in the star ratings based on a number of aspects, including variation in performance among hospitals for that measure or how much measures correlate to each other.

    The emphasis the model gives to each measure isn't decided by the CMS, but done strictly by the model.

    "The advantage of this approach is it doesn't include some of the more arbitrary decisions that would happen if you were to apply an explicit weight" to each measure, said Dr. Arjun Venkatesh, a scientist at the Center for Outcomes Research and Evaluation at the Yale School of Medicine.

    The CMS contracted with Yale to develop the methodology. The selection of the methodology involved feedback from consumers, hospitals, public-reporting experts and methodology experts.

    The model is used to determine how hospitals perform in seven categories: mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care and efficient use of medical imaging. The three outcome groups—readmissions, safety and mortality—are each weighted the most at 22% each, as is patient experience.

    Each of the categories have a certain number of measures that the model will assign a loading coefficient, which determines how much emphasis each measure gets in each category. For example, in the mortality group, the model considers seven measures that make up 22% of the total group.

    In the first four iterations of the CMS star ratings, the PSI-90 measure accounted for about 98% of a hospital's performance in the safety of care category because that is where the model likely saw the most variation in performance compared to the other measures in the domain, so the model assigned it the heaviest loading.

    "I wouldn't necessarily see that as a good or a bad thing," the CMS official said.

    The PSI-90 measure is a composite measure that looks at a variety of safety issues like pressure ulcers and sepsis rates, which can affect a lot of patients. While the CMS doesn't select which measures receive more emphasis, the agency believes PSI-90 rates indicate overall quality of care more accurately than other measures in the category.

    However, in the proposed June release of the star ratings, the latent variable model, for the first time, assigned about 98% of a hospital's performance in the safety of care category to complication rates from hip and knee replacements. This change dramatically changed how a subset of hospitals performed on the star ratings, with some scores dropping or rising by two stars.

    The CMS official said the agency was aware of the change "right away," even before it sent hospitals the preview report in May.

    The agency determined that more emphasis was likely given to the measure for complication rates from hip and knee replacements because of the significant changes that have happened to the PSI-90 measure over the past two years.

    The proposed June release accounted for the fact that coding for PSI-90 changed from ICD-9 to ICD-10. Additionally, the Agency for Healthcare Research and Quality recently removed some measures from PSI-90 in response to stakeholder concerns about the measure.

    "It's not surprising that when you update a measure that hospital performance is going to change, and therefore the star rating is going to change," the CMS official said.

    Although the CMS official said she wasn't surprised the change occurred, the agency is going to convene a technical expert panel to determine "statistical applications we can use within the existing methodology that can attenuate the impact" that measurement changes can have on hospitals' overall star ratings. The official added, "It wouldn't mean changing the methodology."

    The CMS stands by the hospital star ratings, she said. "We believe it's still rigorous, accurate and reliable; and the kind of changes we saw that led to the delay, that could've been expected."

    Tags: Patients, Centers for Medicare & Medicaid Services (CMS), Transformation, CMS star ratings, Transformation Hub
    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    long covid.png
    Most with long COVID were never hospitalized, study finds
    GettyImages-614627558_WEB.jpg
    Financial training linked to health improvement, study finds
    Sponsored Content
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2022. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Transformation Summit
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain Revenue Cycle
        • - Hospital at Home
        • - Workplace of the Future
        • - Virtual Health
        • - Future of Healthcare Staffing
      • Custom Media Event: ESG Summit
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing